For surgery patients, blood bank minimum order request

[prhe38]

At my hospital we have a Maximum surgical blood ordering list in which tells the OR staff what is needed for that surgery case. For example: Iff you are having a AAA the standing order is 2 units, if you were having a Cysto TURP you have just a T&S ordered. My question is, is this a common practice or does your surgeon have to write orders in which states what he or she wants to have drawn on that patient and how many units they are requesting.

I wondering if this is an old policy or is it still out there. Please let me know

Pat

[tbostock]

Yes, we have one also. This way the surgeon does not have to order units for each patient because the med staff approves the MSBOS list each year. It's not set in stone; if the doc orders more due to clinical issues with the patient, or if the patient's starting hemoglobin level is very low, we crossmatch a couple. Also, if the patient has an antibody, it is our policy that we crossmatch two units, since antigen typing and an IgG crossmatch is necessary.

[David Saikin]

Good answer

[prhe38]

Thank you

[Malcolm Needs ☆]

Hi Pat,

Yes, the MSBOS has been around for an awful long time (since Boral and Henry, if my memory has not gone completely), but is still good for all that (many things that have been around for a long time are still excellent - tube techniques for one!).

Presumably you know the theory behind it (the Transfusion Index and the Cross-matched to Transfusion Ratio [C/T Ratio]) and why it was introduced (the shocking waste of blood tied up on patients who were unlikely to ever use it, and the expense of cross-matching this blood). If not, I would suggest you read some of the work done by John Judd on this subject.

With the advent of electronic issue (EI) (N.B. NOT electronic cross-match - as you don't actually do a cross-match) the use of an MSBOS is becoming less common, but still remains the bedrock of establishments that do not perform EI, or should do, if they have any respect for their Blood Bank and, more importantly, the blood donors.

[Malcolm Needs ☆]

Sorry, dinner was ready half way through my post.

To continue....

There are very good reason why MSBOS is an extremel useful thing.

Firstly, it helps to remeber that the MSBOS is individual to the surgical procedure, the surgeon, the hospital and to the patient.

The idiocyncrasy of the surgical procedure is obvious (one would not require the same blood cover for an in growing toenail as one would for a bilateral re-do of a total hip replacement - I hope).

Some surgeons take on more difficult cases than others, for the same surgical procedure.

Some hospitals have many surgeons that do the above.

A particular patient may have a potential bleeding problem (e.g. they are on aspirin) whilst others may not.

It is an ideal way to improve the relationship between the Blood Bank and one's surgical/anaesthetic colleagues, in as much as it is just as valuable to suggest to them that they may need more blood cover, rather than less.

To sum up, the MSBOS is brilliant for those hospitals that do not yet undertake EI as it saves on the waste and expense of blood, whilst being safe for the patient and helping keep the Blood Bank on the "right side" of their colleagues in other departments.

[Tonyd]

Excellent answer Malcolm !

I wonder if we need to move away from calling it 'MAXIMUM surgical blood order schedule' as sometimes the implication (in the anaesthetists' minds at least!) is that the figure quoted is all they can have.

As with all clinical transfusion policies, involvement of the clinicians in writing it pays dividends in the long run.

It's a great starting point as a tariff for the types of operation performed in your particular hospital and good communications between anaesthetists and the lab allows sensible negotiation for more difficult patients.

[richardsonj]

We have the same concept as tbostock. We call it the "Surgical Blood Order Schedule" and leave maximum and minimum out of it. We also have a "double" rule for anyone who has an antibody. (If the schedule requires a TS, we set up 2 units, if it requires 2 units, we set up 4 etc.)

[EDibble]

We have not had a "standing order list" (as we used to call it) for many years. The surgeons order on a case by case basis. There are rarely any mix ups on the doc's end, but sometimes the patients do not come in ahead of time for their blood work, and then we see a AAA or a Total Hip Replacement on the OR schedule with not even a Type and Screen ordered. A few phone calls are made, and the issue is usually resolved.

We in BB monitor the OR list daily, after all, we are the ones who will get screamed at in the middle of a bleeding crisis.

:rolleyes:

[AMcCord]

I wish I had access to the OR list. I "do not need to know". All those surprises (antibodies, etc) keep the blood flowing in the morning!

[Auntie-D]

I wish I had access to the OR list. I "do not need to know". All those surprises (antibodies, etc) keep the blood flowing in the morning!

Keep asking - make them think that you are going to make their job easier (which you are). We get our theatre list for the next week on a Friday morning to allow us to order enough blood to cover any surgeries. I argued that it would seriously benefit me running the transfusion service and cut down wastage - and it has...

Keep at them - they'll give in eventually

[Malcolm Needs ☆]

I wish I had access to the OR list. I "do not need to know". All those surprises (antibodies, etc) keep the blood flowing in the morning!

If they "think" you do not need to know, they are not thinking.

Delay their surgical procedures a couple of times, if you possibly can; that'll change their minds (and make them realise how important their Blood Bank is to them)!!!!!!!!!!!!!!!.................but try not to inconvenience the patient - an almost impossible combination, I know.

:devilish::devilish:

[AMcCord]

I've been fighting this battle for years and haven't made a dent yet. They cite patient confidentiality??!!!!??!!! most often. I am, however, the original squeaky wheel needing greased, and some year, in a galaxy far, far away, I may yet wear them down!

As to the delay of surgery, the surgeon will call and tell me to "just keep trying to find something" or "it's not my problem". Love the last one and so does anesthesia! We feel like magicians sometimes...nothing up my left sleeve, but look what I just pulled out of my hat!

[Auntie-D]

I've been fighting this battle for years and haven't made a dent yet. They cite patient confidentiality??!!!!??!!! most often. I am, however, the original squeaky wheel needing greased, and some year, in a galaxy far, far away, I may yet wear them down!

As to the delay of surgery, the surgeon will call and tell me to "just keep trying to find something" or "it's not my problem". Love the last one and so does anesthesia! We feel like magicians sometimes...nothing up my left sleeve, but look what I just pulled out of my hat!

Patient confidentiality? Yet they send you samples with the patient's names on lol...

As far as providing blood cover if they have a positive antibody screen - we have our policy written that if an antibody is identified we need 72 hours to provide blood (covers us for shipping from elsewhere). Just tell them that the blood isn't ready yet when they ask and they'll soon come round... I insist that for elective surgeries phenotyped blood must be given - none of the xm compatible nonsense. If the patient isn't yet cut, they can wait!

[carolyn swickard]

There is a slight possibility that if you took a poll from this site and asked how many other Blood Banks have access to the "secret" surgery schedule (probably many) - you might be able to use that as "data" to help you get access to your hospital's surgery schedule. We do have access to the surgery schedule here, but it is controlled by the IT folks and only certain techs in the Lab (those on the Blood Bank team only) have access to the schedule. It is very!!!! useful and the restricted access seems to satisfy the HIPPA requirements. We have Meditech here and access is controlled by the "Access" restrictions on each individual computer user. Good luck.

[Deny Morlino]

A printed copy is provided early afternoon for the following day's schedule for the pathology secretary, the hisotologist, and for blood bank. It is invaluable to us as surgeries are canceled between pre admission testing and the day of surgery. Without the schedule many phone calls and wasted time for both departments would result. We are also responsible for obtaining repeat draws the day of surgery for appropriate surgical cases requiring a crossmatch. Knowing what the SOP for arival time for a given type of surgery is we can catch the patient upon admission without disrupting the final presurgical process. Just some thoughts.

P.S. Blood bankers have enough surprises on a day to day basis. Eliminating a few is a huge help!!

[DPruden]

Does anyone know if there is a JCAHO requirement surrounding this topic? We do not have maximums setup at my facility, but it would be nice to have!